APTA Summary Available for National Proposed Coverage TENS Treatment for CLBP

Tuesday, April 03, 2012

APTA Summary Available for National Proposed Coverage TENS Treatment for CLBP

APTA has posted a summary of the recent National Coverage Analysis Proposed Decision Memo from the Centers for Medicare and Medicaid Services (CMS) regarding transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP). For patients meeting the specified definition of CLBP in the memo, CMS proposes coverage only when those patients are enrolled in a clinical study. The clinical study must address whether TENS provides a clinically meaningful reduction in pain, improvement in function, or reduction in other treatments or services. In addition, the study must adhere to specified standards of scientific integrity and relevance to the Medicare population.

CMS will accept public comment on this proposed decision memo through April 12. APTA will submit comments on behalf of membership.

The summary is available to APTA members on the Medicare Coverage Issues webpage under the "TENS" heading.

Comments

Kind of silly. I wonder how much Medicare pays for a TENS unit. I am aware that TENS units vary in quality but adequate units are available on the internet for under $50. For under $50, meaningful use would be if it prevented one PT visit. This is a really expensive proposal for an intervention that should cost medicare $20 (volume purchase) and people might like it. I admit, this is not at all scientific but the amount they are proposing to spend on this should be spent elsewhere. Or, maybe there are other PTs that feel this is something that really needs to be addressed. Please spent the money helping us learn to classify patients and determine the appropriate combination of interventions. The TENS study will fail because "CLBP" is not a homogenous group of people. There are at least 10 different physical and psychological/social aspects that contribute to LBP--throwing a TENS unit at it doesn't make that much sense independent of addressing many other issues.

Electrical stimulation [ES]for pain modulation can be an inexpensive adjunct to pain management for a variety of patients. Skin electrode ES may have limited temporal efficacy and the key is to find the source of pain and eradicate it, if possible. Individuals with chronic low back pain are among those who need to be diagnosed because the source of their pain is still present. [Complete assessment of nerve function via EMG and Evoked Potential Studies is frequently missing and MRI does not predict nerve function.] I agree, PT evaluation for the efficacy of ES as a temporary measure is indicated and then perhaps one follow up visit to document the use of ES and the objective benefits. Devices can be purchased for $50-100.00. All of this improves the patient's function at a reduced cost until appropriate intervention can be taken. If the source of the pain cannot be eradicated, evaluation for spinal cord stimulation for pain modulation is indicated. SCS results in longer lasting pain modulation. The terminology in the memo is unfortunate. TENS refers to the skin application of ES and there are many potential reasons to administer ES in such a fashion. Pain modulation is only one. [You could stick your finger in an electrical outlet and do "TENS."] In general, when patients are accurately diagnosed their treatment can be designed to eliminate the source of the pain without relegation to the chronic pain patient group, which is far more expensive in the long run. Joyce Campbell, Ph.D., P.T.

Posted by Joyce Campbell -> CGU\B
on 4/8/2012 10:58 AM

The effective use of TENS can reduce the spasms and pain and decrease the need for medications. The electrical stimulation of acupuncture points have been documented for many years and has been extremely beneficial for thousands of patients. The idea of requiring this to be during a clinical study is ridiculous and not cost effective. There are too many government regulations already. I would love to treat one of the legislators proposing this. They would get a charge out of this, but in a good way. Ken Lamm PT

Posted by Ken Lamm PT
on 4/9/2012 11:54 PM

I hope CMS is prepared to pay much more for opiod prescriptions for patients with CLBP rather than the $50-100 a typical TENS unit costs and perhaps would keep patients from requiring opiods for pain control.